title: Impact of intraperitoneal pressure and duration of surgery on levels of tissue plasminogen activator and plasminogen activator inhibitor-1 mRNA in peritoneal tissues during laparoscopic surgery.
abstract: BACKGROUND
  Our objective was to evaluate the impact of intraperitoneal pressure (IPP) and duration of a CO(2) pneumoperitoneum on the peritoneal fibrinolytic system during laparoscopic surgery.
  
  
  METHODS
  Human study: Patients undergoing laparoscopic surgery were divided into two groups: low (8 mmHg, n= 32) or standard (12 mmHg, n= 36) IPP. Normal peritoneum was collected from the parietal wall at the beginning of surgery and every 60 min thereafter. Mouse study: Mice were divided into three groups: low (2 mmHg) or high (8 mmHg) IPP or laparotomy. Peritoneal tissue was collected at 0, 4, 8, 24, 48 and 72 h, and 5 and 7 days after surgery. Real-time RT-PCR was performed in humans and mice to measure the levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) mRNA in peritoneal tissues.
  
  
  RESULTS
  Human study: The tPA/PAI-1 mRNA ratio was significantly decreased in the 12 mmHg group at 1 h [P < 0.0001 versus matched initial peritoneal biopsies (MI)]. The tPA/PAI-1 mRNA ratio decreased in both groups at 2 h (P < .0.01 versus MI). Mouse study: The tPA/PAI-1 ratio was decreased at 0 h, and the difference was significant at 4 h in both the laparotomy (P < 0.001 versus controls, 0 h, 5 and 7 days) and high-IPP (P < 0.0001 versus 0, 48 and 72 h, 5 and 7 days) groups. No changes in tPA/PAI-1 ratio were observed in the low-IPP group.
  
  
  CONCLUSIONS
  A low IPP and shorter duration of surgery appear to minimally impact the fibrinolytic system during a CO₂ pneumoperitoneum.
authors.affiliation: Chirurgie Gynécologique, CHU Clermont-Ferrand, Clermont-Ferrand, France. sachikoma@aol.com
authors.forename: Sachiko
authors.initials: S
authors.lastname: Matsuzaki
authors.forename: Revaz
authors.initials: R
authors.lastname: Botchorishvili
authors.forename: Kris
authors.initials: K
authors.lastname: Jardon
authors.forename: Elodie
authors.initials: E
authors.lastname: Maleysson
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
authors.forename: Gérard
authors.initials: G
authors.lastname: Mage
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D010535:Laparoscopy; D051379:Mice; D008810:Mice, Inbred C57BL; D010537:Peritoneum / Q000378:metabolism*; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics / Q000378:metabolism*; D010960:Plasminogen Activators / Q000235:genetics / Q000378:metabolism*; D011312:Pressure; D012333:RNA, Messenger / Q000378:metabolism
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D012333:RNA, Messenger; D010960:Plasminogen Activators